Chapter 3 of EM 385-1-1 focuses on first aid and medical requirements, outlining the necessary provisions for ensuring the health and safety of personnel in various work environments. It details training qualifications for first aid and CPR, the implementation of AED programs, and the requirements for first aid kits, stations, and health clinics based on the number of employees and the accessibility of external medical support.
The chapter also addresses specific needs related to potential exposure to bloodborne pathogens and biological or environmental diseases.
Summary and Key Takeaways by Section
Section 3-1
References. Lists specific references for Chapter 3.
Section 3-2
Definitions
- Health Care Provider: Defined as a doctor of medicine or osteopathy authorised to practice medicine or surgery in their state, or any other person deemed capable of providing health care services by the Secretary of Labor. This includes podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (with limitations), as well as nurse practitioners, nurse-midwives, clinical social workers, and physician assistants authorised to practice under state law and performing within their scope of practice. The definition also extends to health care providers authorised to practice in other countries according to their local laws and scope of practice.
- First Aid Station: The designated place at an event where individuals can seek medical treatment if they become ill or are injured.
- Other Potentially Infectious Materials: Defined as human body fluids (semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid), any body fluid visibly contaminated with blood, and all body fluids where differentiation is difficult; unfixed human tissues or organs; and HIV or HBV containing cultures, media, or infected tissues.
- Near Proximity: Emergency care must be available within no more than 3-4 minutes from the workplace.
Section 3-3
Personnel Required Qualification/Training
Based on work activities, there may be situations requiring additional personnel training/qualifications as identified in applicable chapters (e.g., chapters 6, 9, 11, 19, 30). Paragraph 22(a) specifies that in non-rural locations, where a first aid station is not mandatory for 100-299 employees, at least two employees per shift must be CPR certified. Paragraph 22(c) mandates that a certified first aid attendant must be on duty in first aid stations whenever work is in progress (except during emergency calls). Paragraph 22(7) requires that all employees working where a first aid kit is located must be trained according to paragraph 3-3. Paragraph 21(b) requires that the battery and functionality of Automatic External Defibrillators (AEDs) must be checked at least monthly or according to manufacturer’s instructions or stricter local regulations.
Paragraph 21(b) also mentions the need for appropriate licensed Health Care Provider programmatic involvement and oversight according to FDA and/or state guidance for AED Programs.
Section 3-4
Roles and responsibilities specific to Chapter 3. The requirements for certified first aid attendants and the oversight by Health Care Providers in AED programs imply defined responsibilities for these individuals.
Section 3-5
Inspection Requirements
Paragraph 21(b) states that the battery and functionality of AEDs must be checked at least monthly or as per manufacturer’s instructions or stricter regulations, with these checks being documented. Paragraph 21(a)(5) within Chapter 35 (Sanitation) mentions inspection and oversight methods to ensure adherence to a site-specific Exposure Control Plan related to bloodborne pathogens. This suggests that Chapter 3 might detail inspection requirements for first aid supplies, stations, and health clinic facilities to ensure readiness and compliance.
Section 3-6
Activity Hazard Analysis (AHA) Requirements
Paragraph 21 states that AHAs must be developed according to paragraphs 1-6 or 2-6, as applicable. This general requirement extends to activities where first aid or medical responses might be necessary. The AHAs should identify potential medical emergencies as hazards and detail the planned controls and procedures.
Section 3-7
Minimum Plan Requirements
- Site-Specific Exposure Control Plan: A written plan is mandatory when employees may be exposed to blood or other potentially infectious materials during their job duties. This plan must be developed according to 29 CFR 1910.1030 and include: a detailed description of work activities with potential exposure; anticipated hazards and control measures (e.g., universal precautions, engineering and administrative controls, PPE, housekeeping, hepatitis B vaccination, training, labels and signs); a Post Exposure Control Protocol for immediate medical evaluation following potential exposures (addressing HIV, HBV, HCV, and other CDC-identified diseases, following applicable regulations); recordkeeping procedures; and inspection and oversight methods to ensure plan adherence and annual updates or more frequent updates when necessary.
AED Program: A written AED Program is required when AEDs are available for employee use. This program must include at least: training and retraining (as per para 3-3); and appropriate licensed Health Care Provider programmatic involvement and oversight according to FDA and/or state guidance.
Section 3-8
General Requirements
- First Aid Kits: Paragraph 22(e)(1) specifies that a first aid kit(s) according to paragraph 3-8.c is required for all projects, activities, or contracts (USACE or contractor operated) under the following conditions:
- Less than 100 employees on the shift, and neither a first aid station nor a health clinic is available.
- The site is not in near proximity to a hospital, medical clinic, or doctor’s office with coordinated emergency medical support.
- Automatic External Defibrillators (AED): Their placement is optional (except in health clinics) but strongly recommended. A time and distance assessment to EMS and a justification are required before placing AEDs on a worksite. When AEDs are present, an AED Program must be developed (see para 3-7.b). For ease of use and maintenance, all AEDs within a location/Command should ideally be the same manufacturer and model. USACE facilities should refer to “Guidelines for Public Access Defibrillation Programs in Federal Facilities” for guidance.
- First Aid and Medical Facility Requirements:
- First Aid Stations: Must be established and equipped at projects/contracts (USACE or contractor operated) with 100 to 299 employees on the shift. In non-rural areas, this requirement is waived if at least two employees per shift are CPR certified and a first aid kit is available, provided emergency medical support is readily available from a nearby coordinated facility. For tunnel excavation, a first aid station and transportation for prompt treatment in near proximity are mandatory. A certified first aid attendant must be on duty during all working hours (except for emergencies).
- Health Clinics: Required for all medium, high, or extremely high-risk operations/contracts (USACE or contractor operated) with 300 or more employees on the shift. These clinics must be equipped as directed by a Health Care Provider and provide privacy, adequate lighting, climate control, toilet facilities, hot and cold water, drainage, and electrical outlets, with specific finishing requirements for walls, ceilings, and floors. In remote locations requiring a health clinic but lacking nearby medical care, a properly equipped emergency vehicle, helicopter, or mobile first aid unit must be provided during work hours (with specific conditions for helicopter use). A qualified medical professional (RN, certified EMT-I/P, or LPN with Health Care Provider oversight as per state law) must be assigned full-time to each installation requiring a health clinic. Health clinics must also be equipped with an AED. The type of facilities and equipment for first aid stations/health clinics should be determined considering the proximity and quality of available medical services, following Health Care Provider recommendations. Alternative facilities offering equivalent services may be used with Health Care Provider approval. The locations of first aid stations and health clinics must be clearly marked and provided with emergency lighting. Administrative work locations (e.g., district/regulatory offices) must have either an accessible staffed infirmary or a medical clinic/hospital/doctor’s office accessible within 15 minutes with coordinated emergency support; if an external facility is used, the administrative site must have ANSI Z308.1 compliant first aid kits and at least two employees per shift certified in first aid and CPR.
- Drenching and Flushing Facilities: Must be provided in work areas with potential exposure (of any body part) to toxic or corrosive materials for immediate emergency use (see chapter 6).
- Bloodborne Pathogens (BBP): This paragraph applies when employees may be exposed to blood or other potentially infectious materials, including those designated to provide first aid. In addition to these requirements, compliance with 29 CFR 1910.1030 is mandatory. Employers must provide and ensure the use and maintenance of appropriate PPE (e.g., breathing barriers, latex-free gloves, gowns, masks, eye protectors, resuscitation equipment) when rendering first aid to prevent contact with BBPs. A site-specific Exposure Control Plan must be established according to paragraph 3-7, and necessary employees must be trained according to paragraph 3-3.
Biologic and Environmental Diseases: Before work outside an employee’s normal geographic area, employees must be informed of endemic parasitic, bacterial, viral, and environmental diseases (e.g., Lyme Disease, West Nile Virus, Hantavirus, Histoplasmosis, Rocky-Mountain Spotted Fever, Dengue Fever, Malaria). Guidance on potential diseases in the work location should be sought from sources like the CDC Travelers Health webpage and local health departments. Employees traveling to endemic areas must receive information on: modes of transmission; specific health risks; preventive measures (vaccines, PPE); appropriate work practices to prevent contact with infected agents; vaccine information; safe removal of the source; and symptom recognition and medical referral.
Section 3-9
Figures and Tables
Table 3–1: Requirements for Basic First Aid Unit Package
Section 3-10
Checklists and Forms
There are no checklists or forms specific to Chapter 3.
Chapter 3 Review
In conclusion, Chapter 3 of EM 385-1-1 This chapter outlines the necessary provisions for ensuring the health and safety of personnel in various work environments.
By adhering to the principles and requirements outlined in this chapter, USACE aims to create and maintain safe and healthy work environments for all personnel. Chapter 3 is covered in full in all EM385-1-1 training courses.
